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Enucleation is appropriate for the vast majority of patients with BPH, but certain patient profiles—including prior radiation, significant neurologic conditions, morbid obesity, and dementia—warrant caution or referral to specialists, whereas the most consistent technical failure among surgeons past their learning curve is inadequate apical tissue removal driven by discomfort with sphincter proximity, according to Amy E. Krambeck, MD.

A health-economic analysis of the ASPIRE trial data found that the steerable ureteroscopic renal evacuation (SURE) procedure was linked to roughly $3464 in downstream savings per patient over 2 years compared with standard ureteroscopy, with lead investigator Brett Johnson, MD, framing this as a value-committee benchmark rather than a full cost comparison, since the analysis deliberately excludes the index procedure's incremental cost due to wide variability across payers and care settings.